Treatment analysis systems and methods

ABSTRACT

A dental treatment planning system includes an input form to receive one or more dental patient inputs; and an engine adapted to receive the dental patient data from the input form and validating the dental patient data in a predetermined sequence

CROSS-REFERENCE

This application is a continuation of U.S. application Ser. No.14/511,119, filed Oct. 9, 2014, which is a continuation of U.S.application Ser. No. 12/539,553, filed on Aug. 11, 2009, now U.S. Pat.No. 8,930,219, which is a continuation of U.S. application Ser. No.09/557,382, filed on Apr. 25, 2000, now abandoned. The contents of eachof which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

The invention relates generally to the field of orthodontics and, moreparticularly, to computer-automated orthodontic treatment of teeth.

Tooth positioners for finishing orthodontic treatment are described byKesling in the Am. J. Orthod. Oral. Surg., 31:297-304 (1945) and32:285-293 (1946). The use of silicone positioners for the comprehensiveorthodontic realignment of a patient's teeth is described in Warunek etal., J. Clin. Orthod., 23:694-700 (1989). Clear plastic retainers forfinishing and maintaining tooth positions are commercially availablefrom Raintree Essix, Inc., New Orleans, La. 70125, and Tru-TainPlastics, Rochester, Minn. 55902. The manufacture of orthodonticpositioners is described in U.S. Pat. Nos. 5,186,623; 5,059,118;5,055,039; 5,035,613; 4,856,991; 4,798,534; and 4,755,139. Otherpublications describing the fabrication and use of dental positionersinclude Kleemann and Janssen, J. Clin. Orthodon., 30:673-680 (1996);Cureton, J. Clin. Orthodon., 30:390-395 (1996); Chiappone J. Clin.Orthodon., 14:121-133 (1980); Shilliday, Am. J. Orthodontics, 59:596-599(1971); Wells, Am. J. Orthodontics, 58:351-366 (1970); and Cottingham,Am. J. Orthodontics, 55:2331 (1969). Kuroda et al., Am. J. Orthodontics,110:365-369 (1996) describes a method for laser scanning a plasterdental cast to produce a digital image of the cast. See also U.S. Pat.No. 5,605,459.

U.S. Pat. Nos. 5,533,895; 5,474,448; 5,454,717; 5,447,432; 5,431,562;5,395,238; 5,368,478; and 5,139,419, assigned to Onnco Corporation,describe methods for manipulating digital images of teeth for designingorthodontic appliances.

U.S. Pat. No. 5,011,405 describes a method for digitally imaging a toothand determining optimum bracket positioning for orthodontic treatment.Laser scanning of a molded tooth to produce a three-dimensional model isdescribed in U.S. Pat. No. 5,338,198. U.S. Pat. No. 5,452,219 describesa method for laser scanning a tooth model and milling a tooth mold.Digital computer manipulation of tooth contours is described in U.S.Pat. Nos. 5,607,305 and 5,587,912. Computerized digital imaging of thejaw is described in U.S. Pat. Nos. 5,342,202 and 5,340,309. Otherpatents of interest include U.S. Pat. Nos. 5,549,476; 5,382,164;5,273,429; 4,936,862; 3,860,803; 3,660,900; 5,645,421; 5,055,039;4,798,534; 4,856,991; 5,035,613; 5,059,118; 5,186,623; and 4,755,139.

U.S. Pat. No. 5,975,893, assigned to the assignee of the instantinvention, describes a system for repositioning teeth using a pluralityof individual appliances. The appliances are configured to be placedsuccessively on the patient's teeth and to incrementally reposition theteeth from an initial tooth arrangement, through a plurality ofintermediate tooth arrangements, and to a final tooth arrangement. Thesystem of appliances is usually configured at the outset of treatment sothat the patient may progress through treatment without the need to havethe treating professional perform each successive step in the procedure.

BRIEF SUMMARY OF THE INVENTION

A dental treatment planning system includes an input form to receive oneor more dental patient inputs; and an engine adapted to receive thedental patient data from the input form and validating the dentalpatient data in a predetermined sequence.

Implementations of the system may include one or more of the following.The engine prompts the user for additional data based on previousentries. The treatment includes a diagnostic phase, a goal phase and atreatment path determination phase. The engine checks validity for dataentered intra-phase. The validity of the entries is determined bycrosschecking against a mutually exclusive condition. The engine checksvalidity for data entered inter-phase. The engine checks whether thetreatment results in an improvement in the patient. The engine checkswhether the treatment meets an efficiency guideline or a prudencyguideline. The engine can also check the treatment plan againstproperties of an appliance.

Advantages of the system include one or more of the following. Thesystem improves the accuracy and validity of diagnoses and treatmentplan by providing the orthodontist with information and resources tomake the measurements that will result in the correct diagnosis.

The system also prevents an orthodontist from entering conflictingdiagnoses. Because a patient's teeth and the way they define a bite areinterrelated, a series of logical rules are used to crosscheck thediagnoses and to prevent an invalid diagnosis. The system also checksfor and requires the entry of a diagnosis for any area for which one isrequired. This prevents one type of inaccuracy in diagnosis, in that anegative finding is equivalent to an incorrect positive finding.

The system also limits path choices based on the initial and end pointsfor teeth. This prevents an inaccurate path by limiting the path choicesto those that head in the correct direction. The system also preventsfor the orthodontist from entering two conflicting paths. By crosschecking the paths, the system can eliminate invalid paths.

Additionally, certain shortcomings of the appliances with regard to thebiology, physics, and mechanics of tooth movement are known. Thus, thesystem considers the biology, physics, and material of tooth movement inoptimizing the treatment plan. The system prevents the orthodontist fromentering a goal that is not deemed attainable by the system and theinformation can be relayed to the doctor when a valid and accurate planis described that involves these shortcomings. This will allow thedoctor to tailor the plan to avoid any pitfalls inherent in the system.Moreover, the system provides feedback, for example direction andeducation, when the orthodontist is prevented from entering data notallowed by the system. Because there are multiple goals and paths toreach them, a quality result is not guaranteed from an accurate andvalid diagnosis. Feedback when a mistake is made in the diagnosis can beused to educate and direct the thinking of the doctor which will perhapslead to the redevelopment of an entirely new, better, plan, rather thanthe mere correction of the error which generated the feedback.

In implementations that permit communications over the Internet, thesystem provides information and assistance 24 hours a day, seven days aweek. The system supports a virtual community of dental patients,dentists, specialists such as orthodontists and oral surgeons, financialinstitutions, benefit providers and the providers of dental equipment orservices. For treating professionals, such as dentists andorthodontists, the system provides a one-stop solution for planningpatient treatments, managing communication with patients, storingpatient records and sharing records with relevant persons outside thedoctor's office. The system can act as the repository for the file notesand visual imagery (photographs, x-rays and virtual treatment plans)associated with the course of treatment. The doctors will control accessto the centralized patient file. Various tools are provided to supportthe interpretation of information and the diagnostic process. Forexample, the system allows the doctors to retrieve, and analyze patientinformation and to simulate using two and three-dimensional visualimagery of the patient's teeth and other anatomical structures. Thesystem supports visualization of the expected outcome of a particularcourse of treatment. Working together with the patient these images canenhance the patient's understanding of the benefits of treatment and actas a valuable selling tool for the doctor. The system also providesdiagnostic decision-support capabilities such as visualizing theplacement of implantations, veneers and crowns before or after a courseof treatment to straighten the teeth. The system provides an animatedprediction of the suggested treatment that helps the patient and thedoctor to visualize the pace of treatment. Using these tools, the doctorcan easily and quickly view and/or edit the treatment plan. When doctorand patient choose the final treatment plan the system disseminatesaspects of the plan and the relevant patient records to the appropriatemembers of the virtual community, thus reducing the cost and delayassociated with tradition physical shipment of patient information.Aspects of the final treatment plan can be used to generate appliancesused in the physical treatment. The information associated with thepatient's treatment (visual images, virtual treatment plans, file notesand the like) are digitized and maintained in a central storage facilityin a secure manner. Doctors and patients can have access to these fileswithout the need to extract files and models from storage and withreduced risk of records being misplaced.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagram of an exemplary environment supporting electroniccommerce.

FIG. 2 is a diagram of a server to support electronic commerce.

FIG. 3 is a diagram of a web site on the server of FIG. 2.

FIG. 4 is a flowchart of a process for a patient receiving dentaltreatment.

FIG. 5 is a flowchart of a process for a treating a dental patient.

FIG. 6 is an exemplary output showing a treatment plan form and a 3Dview of teeth with a browser.

FIG. 7 is a flowchart of a process to diagnose and generate a patienttreatment plan.

FIG. 8 is one exemplary implementation of FIG. 7.

FIG. 9 is a diagram of a system for manufacturing appliances.

FIG. 10 is a diagram illustrating a computer system to support thefabrication of appliances.

DETAILED DESCRIPTION OF THE INVENTION

Referring now to FIG. 1, an environment supporting a dental system 100is shown. The system 100 communicates over a network 102 that can be alocal area network or a wide area network such as the Internet. TheInternet has become a significant medium for communication and commerceand has enabled millions of people to share information and conductbusiness electronically. The unique characteristics of the Internet suchas its ability to provide enhanced communication, rich text, and graphicenvironment provide an ideal support for a wide variety of electroniccommerce transactions. The ubiquity and convenience of the Internetmakes it ideal for dispensing information on certain topics thattraditionally require visits to specialists. For example, certainconsumers may be interested in products and services associated withorthodontics and dentofacial orthopedics that specializes in thediagnosis, prevention and treatment of dental and facial irregularities(“malocclusion” or “bad bite”). The orthodontic treatment processtypically uses corrective appliances such as braces and/or other fixedor removable appliances to bring the teeth, lips and jaws into properalignment and to achieve a facial balance. The pervasiveness of theInternet makes it an ideal source for information relating to theseproducts and services.

One or more client computers 104-105 can be connected to the network102. In one embodiment where the network 102 is the Internet, the clientcomputers execute a suitable browser such as Navigator from Netscape,Inc. and Internet Explorer from Microsoft Corp. By clicking on thehighlighted text (or specific graphic image), the user can jump from thecurrent web page to a new web page address associated with the link—withthe new page displayed on the screen. In this manner, the user can “surfthe web” by clicking on an almost endless succession of links going topage after page all following a common thread as defined by the text orgraphic component of the link label.

Through the network 102, the client computers 104-105 can access adental server 106. The dental server 106 serves a web site, a portal, avortal, or a content site for providing dental related information tointerested parties such as dental patients, dentists, orthodontists, andothers. When sensitive information is communicated through the dentalserver 106, such information is securely encrypted using Secure SocketsLayer (SSL) technology throughout the transaction. The server 106 can bea stand-alone computer or can be a server farm that can distributeprocessing and communications activity across a computer network so thatno single device is overwhelmed. During load balancing, if one server isswamped with requests, excess requests are forwarded to another serverwith more capacity.

The network 102 connects the dental server 106 to one or more treatingprofessional workstations 108-109. The workstations 108-109 allowtreating professionals access to a plethora of services provided by thedental server 106 such as patient treatment and office management, amongothers. The dental server 106 stores information associated with patienthistory on-line in a secure manner. The server 106 also allows thetreating professional to have a comprehensive view of the patient'streatment history at any time using a suitable browser, eliminating theneed to pull treatment files or charts or to look for misfiled or lostcharts. The dental server 106 also provides treating professionals withtools to analyze patient data, for example, tools to reconstruct a 3Dmodel of the teeth. For example, using the browser, the treatingprofessional can request the server 106 to animate the progress of thetreatment plan. When the treating professional arrives at a prescriptionor other final designation, the treatment prescription is used toautomatically generate appliances, as described in more details below.Further, in addition to aiding professionals in treating patients, thetreating professional can perform office management, purchasing andother logistical operations using the browser and the dental server 106.

In addition to communicating with patients and treating professionals,the dental server 106 can communicate with one or more partners 110using the network 102. The partners 110 can be product suppliers,service providers, or any suitable commercial entities. Other possiblepartners include value-added service providers such as third partysoftware providers who provide plug-in viewing and diagnosticenhancements that can be used by the professionals.

In combination, the dental server 106 forms a hub that links dentalclients using client computers 104-105, treating professionals usingworkstations 108-109, and partners 110 into a living electronic commerce(e-commerce) community.

FIG. 2 shows an embodiment of the server 106. The server 106 includes aweb server 140, a patient information server 142, a resource planning(RP) server 144 and a streaming server 146. In one embodiment, the RPserver 144 runs Microsoft SQL server and provides information relatingto a doctor or a patient such as address and history. See, for example,Table 1. When a patient's case or static snapshots of the case isneeded, the data is pulled from the patient information server 142. Whenmedia data such as video needs to be streamed to a requesting client,the streaming server 146 can send the stream. In one implementation, thestreaming data is stored in QuickTime format on a Linux-based serverrunning the QuickTime server software.

TABLE 1 Case Type Question Prompts/Printed Statements Answer ChoicesPlease select which Align Mild Spacing Recommended Moderate SpacingTreatment case your patient best Mild Crowding represents. Click allthat apply. Moderate Crowding Narrow Arch Post-orthodontic Relapse

The servers can be clustered. In one embodiment using Microsoft'sCluster Server, cluster-enabled applications such as Microsoft's SQLServer and Exchange. With Cluster Server, two servers can runapplications at the same time. When one server fails, the remainingserver handles its application as well as the failed server'sapplications. Next, the remaining server adopts the IP address of thefailed server and mounts one or more data drives that the two systemsshare. The remaining server is rebooted and applications such as SQLServer can be started and initialized on this server. Persistent clientscan re-attach to the server and continue to operate.

Referring now to FIG. 3, a diagram 200 shows various major functionssupported by the dental server 106. First, the process 200 performs anautomatic detection for the existence of a browser welcome plug-in (step202). If the welcome plug-in exists, an introductory animation (flash)is shown (step 204). From step 202 or 204, the process 200 shows a homepage (step 206) with one or more links. A link is created by having aword in a text field (or a graphic image on a web page) linked to thelocation of another web page, via a string of information setting forththe new web page address presented in hypertext transfer protocol(HTTP), among others.

The user can navigate the home page to join a particular site from aconstellation of related sites. For instance, the user can navigate to apatient's site (step 208), a doctor's site (step 210), a privacystatement site (step 212), one or more additional sites (step 214), andan about site (step 216), among others. The additional sites can be anon-line shopping store that is co-branded with the web site hosted bythe server 106, or the on-line shopping store can be directly affiliatedwith a third party such as planet-rx.com, among others. The additionalsites can also be third party value-added providers of products and/orservices.

FIG. 4 illustrates an exemplary usage of the system of FIG. 1 from atreating professional's perspective. A prospective patient uses a clientcomputer 104 and visits the web site on the dental server 106 (step280). The client identifies a treating professional and schedules anappointment with the treating professional. Alternatively, a referringdentist can refer the client to the treating orthodontist (step 282).The referring dentist can visit the web site on the dental server 106and uses one or more dental esthetic tools to show patients thepotential benefits of anterior and posterior esthetic restorations and,if the patient is interested, refers the patient to the treatingprofessional.

During an initial examination, the treating professional or an assistanttakes a set of digital facial and intraoral images which is uploaded toa secure, collaborative workspace on the dental server 106 (step 284).The workspace is shared with the referring dentist.

Next, the treating professional generates a dentofacial treatmentvisualization showing the patient's face and smile before and aftertreatment (step 286). The treating professional can also combine thepatient's face and an aligner into the intraoral image to show how theinconspicuous the appliance will be (step 288).

Once the patient requests treatment, the treating professional takesimpressions and a bite registration and sends the information to thecompany (step 290). The treating professional also takes a lateral cephand a panorex and uploads them and a treating prescription to theworkspace (step 292). The professional's assistant creates a separateworkspace for the patient, uploads selected “before and after” imagesinto it, and invites the patient to review the images (step 294).

At the company, another professional reviews the records and decides toaccept or decline the case. The models are then scanned, and theintraoral images are retrieved and used to texture-map enamel andgingiva. The data is then sent to the workspace and the treatingprofessional is notified.

In one embodiment, the tooth models may be posted on a hypertexttransfer protocol (http) web site for limited access by thecorresponding patients and treating clinicians. Since realistic modelshave a large volume of data, the storage and transmission of the modelscan be expensive and time consuming. To reduce transmission problemsarising from the large size of the 3D model, in one embodiment, dataassociated with the model is compressed. The compression is done bymodeling the teeth meshes as a curve network before transmission to thetreating professional. Once the curve network is received, the 3D modelis reconstructed from the curve network for the treating professional toanalyze. More information on the compression is disclosed in aco-pending application having Ser. No. 09/506,419, entitled, “EFFICIENTDATA REPRESENTATION OF TEETH MODEL”, and filed by ELENA PAVLOVSKAIA andHUAFENG WEN on Feb. 17, 2000, the contents of which are herebyincorporated.

The treating professional can, at his or her convenience, check thesetup, and review the information sent in step 300 (step 302). Thetreating professionals can use a variety of tools to interpret patientinformation. For example, the treating professional can retrieve andanalyze patient information through a reconstructed 3D model of thepatient's teeth and other anatomical structures. The professional canview animations showing the progress of the treatment plan to help thetreating physician visualize the pace of treatment. Using these tools,the treating professional can easily and quickly view and/or edit thetreatment plan.

If necessary, the treating professional can adjust one or more teethpositions at various intermediate stages of treatment (step 302). Avariety of diagnostic decision-support capabilities such as automatedteeth collision detection can be used to aid the treating professionalin adjusting the teeth positions.

When the treating professional arrives at a prescription or other finaldesignation, the treatment information is automatically collected by thesystem over the Internet, thus eliminating the cost and delay associatedwith the traditional physical shipping of patient information (step304). These modifications are then retrofitted onto the dataset used togenerate the aligners (step 306).

In order for the orthodontist to treat a case, the orthodontist needs togenerate a treatment plan, typically after performing an initialdiagnosis. A correct initial diagnosis is needed for certain orthodonticappliances such as the Invisalign appliances from Align Technology, Inc.of Sunnyvale, Calif. To optimally use the Invisalign treatment, theorthodontist needs to accurately define the course of treatment at timezero. The interrelationship of all of the teeth to form a particularbite allows the initial diagnoses to be checked against each other forvalidity. However, the entire set of diagnoses can be inaccuratetogether, and would not be caught by such a crosscheck.

FIG. 5 shows a process for treating teeth. First, a treatingprofessional such as an orthodontist or a doctor logs on to a treatmentplanning system (step 350). Next, a diagnosis portion of the treatmentplanning system is displayed (step 352). Also, the system displays a 3Dview of the patient's teeth (step 354). In this case, a static bite 0image is displayed. The bite 0 image refers to the position the teethare in at time zero, or the pretreatment state. The rendering of the 3Dview of the teeth focuses the doctor on problems that need to beaddressed. The teeth displayed on the screen are the actual teeth andbite that will be used to generate the treatment. Because of this, thedoctor is able to accurately plan the treatment by using this view ofthe teeth, as opposed to previously taken photos of the teeth. Anexemplary user interface at step 354 is shown as FIG. 6. This window ofthe teeth shows a 3D rendering of the patient's teeth, which can bemoved in all three planes of space to gain a better view. The window canalso be opened to show further visual diagnostic data such as patientX-rays, photos, or any other data useful for the diagnostic process.

Referring back to FIG. 5, the system prompts the doctor to fill-out thediagnostic portion of the form (step 356). See, for example, Tables 2and 3. The diagnostic portion of the form requires that the doctor inputdata relating to the teeth which are present, their condition, theirposition in the dental arches, their relationship to each other, theirsize, and their alignment. Once the diagnostic portion of the form hasbeen entered, the system performs a validity check of the diagnosticentry (step 358). The entered data can be crosschecked against AlignTechnology's case selection criteria to ensure that the submitted caseis acceptable for treatment.

TABLE 2 Doctor & Patient Information Question Prompts/Printed StatementsAnswer Choices A Doctor's Name B Street Address C City, State, Zip DPhone E email E1 FAX E2 Contact Person F Patient's Name G Age H GenderH1 Chief Concern (Function) Calculate patients Print patient's age. age.

TABLE 3 Diagnosis Question Prompts/Printed Answer Statements Choices IRight Canine Sagittal 2 Full Class II relationship 5 End on Class II 7 2mm Class II 8 1 mm Class II 9 Solid Class I 10 1 mm Class III 11 2 mmClass III 13 End on Class III 16 Full Class III J Left Canine Sagittal 2Full Class II relationship 5 End on Class II 7 2 mm Class II 8 1 mmClass II 9 Solid Class I 10 1 mm Class III 11 2 mm Class III 13 End onClass III 16 Full Class III K Upper midline to facial Centered midlineDisplaced right Enter millimeters Displaced left Enter millimeters LLower midline to facial Centered midline Displaced right Entermillimeters Displaced left Enter millimeters M Upper arch length Nonediscrepancy Spacing Enter millimeters Crowding Enter millimeters N Lowerarch length None discrepancy Spacing Enter millimeters Crowding Entermillimeters O Upper incisor torque Normal Proclined Retroclined P Lowerincisor torque Normal Proclined Retroclined P1 Transverse relationshipUpper and lower in good relationship Maxilla is narrower Mandible isnarrower Q Missing teeth Indicate on grid R Crowns/bridges/facialIndicate on grid restorations R1 Tooth size discrepancy Indicate teethon grid R2 Ankylosed/impacted teeth Indicate teeth on grid R3 CR/COshift? No Yes (Function) If R3 = “Yes” Print “Please note that Alignthen currently only recommends treatment from the CO position.”

The system then displays a treatment goal portion of the form andrequests the doctor to fill this portion of the form (step 360). See,for example, Table 4. The system then performs a validity check of thetreatment goal entry (step 362). Because of the fact that the teeth areall related to each other by virtue of their position, it is possible tocross check the entered treatment goal data against itself, as well asagainst the previously entered diagnostic data. Additionally, it allowsa cross check against Align Technology's case selection criteria forwhat is possible with the system. Thirdly, the answers from eachquestion prompt specific subsequent questions. For example, when atreatment goal input is given, the system checks that the input iscompatible with previous diagnostic input, that the treatment goal isrealistic with what Align Technology deems acceptable, and that thetreatment goal is compatible with other previously entered treatmentgoals. The data that has been input will generate further questions, andeliminate possible questions that do not have to do with that particularpatient.

TABLE 4 Treatment goals Question Prompts/Printed Statements AnswerChoices R2 Treat arches Both Upper only Lower only R3 For limitedtreatment Indicate teeth on grid treat at least S Right Canine Sagittal0 Maintain Relationship 2 Full Class II 5 End on Class II 7 2 mm ClassII 8 1 mm Class II 9 Solid Class I 10 1 mm Class III 11 2 mm Class III13 End on Class III 16 Full Class III (Function) If S = 0 or if S-I = 0then go to V (Function) If ABS (S- Print “The Go to S I) > 3 thenInvisalign System is not currently recommended for such a large sagittalchange. Please attempt a smaller change.” (Function) If R2 = Print“Sagittal Go to S “Lower only” and S-I cannot be > 0 then changedwithout treating upper.” (Function) If R2 = Go to U “Lower only” and S-I< or = 0 then (Function) If R2 = Print “Sagittal Go to S “Upper only”and S-I < cannot be 0 then changed wit out treating lower.” (Function)If R2 = Skip U “Upper only” and S-I > or = 0 then T If I-S < 0 thenAchieve sagittal Distalize upper change by molars Check all that Lowerposterior interproximal reduction apply Upper posterior interproximalreduction U If I-S > 0 then Achieve sagittal Distalize lower molarschange by Lower posterior interproximal reduction Upper posteriorinterproximal reduction V Left Canine Sagittal 0 Maintain Relationship 2Full Class II 5 End on Class II 7 2 mm Class II 8 1 mm Class II 9 SolidClass I 10 1 mm Class III 11 2 mm Class III 13 End on Class III 16 FullClass III (Function) If V = 0 or if V-J = 0 then go to Y (Function) IfABS(V- print “The Go to V J) > 3 then Invisalign System is not currentlyrecommended for such a large sagittal change. Please attempt a smallerchange.” (Function) If R2 = Print “Sagittal Go to V “Lower only” and V-Jcannot be > 0 then changed without treating upper.” (Function) If R2 =Go to W “Lower only” and V-J < or = 0 then Print “Sagittal Go to Vcannot be changed without treating lower.” If R2 = “Upper only” Skip Xand V-J > or = 0 then W If J-V < 0 then Achieve sagittal Distalize uppermolars change by Lower posterior interproximal reduction Upper posteriorinterproximal reduction X If J-V > 0 then Achieve sagittal Distalizelower molars change by Lower posterior interproximal reduction Upperposterior interproximal reduction Y If M = “Spacing” then Eliminateupper Maximum anchorage (Retract anteriors) spacing by Check all thatReciprocal apply closure Minimum anchorage (Protract molars) AB If M =“Crowding” Reduce upper Torque then crowding by anteriors Check all thatExpand posteriors apply Interproximal Indicate on grid reduction AC If N= “Crowding” Reduce lower Torque anteriors then crowding by Check allthat Expand posteriors apply Interproximal Indicate on grid reductionExtract lower Indicate on grid incisor AD If N = “Spacing” then Closespaces Maximum anchorage (Retract anteriors) with Check all thatReciprocal closure apply Minimum anchorage (Protract molars) (Function)If P1 = print “You must “Upper and Lower in expand both goodrelationship” and arches, or either AA or AB = neither, to “expandposteriors” preserve but not both, then transverse” AE If R1 hasinformation Relieve tooth Leave space indicate on grid then sizediscrepancy by check all that Interproximal indicate on grid applyreduction AF Curve of Spee Level (may require attachments) Maintain(Function) If AF = Print “A less than flat Curve of Spee may preventachieving sagittal Maintain and S-I not = correction.” and V-J not 0then AG If P1 = “Maxilla Correct Expand maxilla Narrower” thentransverse relationship by AH If P1 = “Mandible Correct Constrictmaxilla Narrower” then transverse relationship by Check all that Expandmandible apply AI Special instructions Free form text box AJ Will thepatient object Please don't use attachments if attachments are placed?(Align will place them Attachments are fine. only as needed. Results maybe compromised if not used.) AK Has this patient's case Yes been shippedto Align before? No AJ Aligner shipment PreCheck (sets 1-3 arrive in 6weeks, prior to ClinCheck approval) timing Standard (sets 1-12 arrive in8 weeks)

The system then displays a treatment plan portion of the form andrequests the doctor to fill this portion of the form (step 364). Theform now knows the start point of all the teeth (from the diagnosticportion) and the end point (from the treatment goal portion). Specificquestions are generated to guide the doctor through a plan for how toget the teeth from their start to end position. The system then performsa validity check of the treatment plan entry (step 366). This validitycheck ensures that the doctor does not enter two incompatible answersthat would involve the teeth running into each other, or not heading inthe direction of the goal, etc.

Additionally, the system generates a summary of the treatment plan (step368). The summary consists of all of the input of the treatment planningform. It is designed for review by the doctor to allow the doctor toreview all of the entered data and ensure that it is in accordance withwhat he intended.

FIG. 7 shows various phases associated with a treatment plan. First, thesystem captures data relating to a diagnostic phase (step 370). Thesystem performs validity check on the received data before proceeding tothe next phase.

After validating diagnostic phase data, the system then captures datarelating to a diagnostic phase (step 372). The system performs validitycheck on the received data for the current phase (intra-phase) as wellas checking for proper relationships between phases (inter-phase) beforeproceeding to the next phase.

After validating goal phase data and checking for proper relationshipbetween the diagnostic phase and the goal phase, the system thencaptures data relating to a treatment path phase (step 374). Again, thesystem performs validity check on the received data for the currentphase (intra-phase) as well as checking for proper relationships betweenphases (inter-phase) before generating the treatment plan.

FIG. 8 shows an embodiment of the flowchart of FIG. 7. First, theprocess of FIG. 8 receives diagnostic data (step 380). Next, the processchecks whether the data is valid (step 382). If not, the process loopsback to step 380 to validate data for the diagnostic phase.

From step 382, if the data is valid, the process receives treatment goalinput data (step 384). Next, the process checks for valid data (step386). If the data is invalid, the process loops back to step 384 tocollect and validate the goal input data.

From step 386, if the data is valid, the process also checks that thetreatment goal improves the patient's condition (step 388). If thetreatment goal fails to improve the patient, the process loops back tostep 384 to prompt the user to update the treatment goal and to validatethe treatment goal once more.

From step 388, the process of FIG. 8 receives treatment plan path inputdata from the user (step 390). Next, the process validates the treatmentplan path data (step 392). From step 392, the process also checks toensure that the proposed path results in a treatment that is efficientand that follows a desired order (step 394). If the path is undesirable,the process of FIG. 8 loops back to step 390 to receive updatedtreatment plan path data. Alternatively, if the path is acceptable, theprocess exits.

As an example, a doctor may enter, among other things, the followinginformation: Diagnosis; Right Canine Sagittal relationship: End on ClassII (This describes the relationship of the bite of the top teeth to thebottom teeth); Left Canine Sagittal relationship: Class I (Thisdescribes the relationship of the bite of the top teeth to the bottomteeth); Maxillary midline in relation to face: Centered (This describesthe relationship of the middle of the upper front teeth in relationshipto the middle of the face); Mandibular midline in relation to face:Centered (This describes the relationship of the middle of the lowerfront teeth in relationship to the middle of the face); Maxillary archlength: Crowding, 9 mm (This qualifies and quantifies the discrepancybetween the total size of the teeth and the total space available forthem in the mouth); Mandibular arch length: Crowding, 3 mm (Thisqualifies and quantifies the discrepancy between the total size of theteeth and the total space available for them in the mouth).

In this example, the system processes the entries as they are entered,and the doctor is informed to check midlines (right and left sagittalasymmetric, but midlines don't reflect asymmetry). This is because theteeth are being described as one thing, but from three different views.If the system determines that one of the views doesn't match the othertwo, the doctor is informed. In this way the form checks for intraphasevalidity. In one condition, the form can inform the doctor that,“Treatment is not recommended for crowding in any arch greater than 6mm,” because 6 mm has been decided to be the cutoff point foracceptability.

Once achieving a sound diagnosis, the doctor would then be permitted toenter the treatment goals. In this example, the doctor enters thefollowing as the goals: (1) Right canine sagittal relationship: Class I;(2) Left canine sagittal relationship: Maintain; and (3) Treat arches:Lower only (In other words, do not do anything with the top teeth).

In this example, the system notifies the doctor that, “The system doesnot recommended the sagittal changes of the magnitude requested on theright side,” because the distance the teeth need to go from thediagnostic position to the goal position of Class I is too great to bepermitted by the appliance. The system would also instruct the doctorthat the upper arch needs to be treated to achieve a sagittal change.

Now, assuming legitimate responses have been registered, the start point(diagnosis) and end point (goal) have been established, and the pathbetween the two can be delineated by a list of questions generated inthe previous responses. An exemplary treatment plan is (1) Achieve rightsagittal change by: Distalize upper molars (A treatment which positionsthe teeth on the right side to match with the unmoved lower teeth) (2)Relieve maxillary crowding by: Procline incisors; and (3) Relievemandibular crowding by: Procline incisors.

In one embodiment, the system asks a series of other questions regardingtiming of the product delivery, etc. A summary will then be displayedregarding all of the inputs such that the doctor can confirm theentries.

FIG. 9 shows a process 400 associated with a viewer that allows thetreating professional to visualize the patient's teeth over the network102 such as the Internet. In one embodiment, during start-up, a browserchecks for a viewer plug-in module embodying the process 400 in a“plug-ins” subdirectory (Windows) or Plug-ins folder (Mac OS) in thesame folder or directory as the browser (step 402). If the viewerplug-in module is available, the browser looks for a MIME type andextension info from the version resource. Through a TYPE attribute, thebrowser knows the MIME type and can load a registered plug-in first and,if there are no matches for the MIME type, the browser looks for ahelper application.

Once the viewer plug-in is identified, the browser loads the viewerplug-in code into memory (step 404); initializes the viewer plug-in(step 406); and creates a new instance of the viewer plug-in (step 408).When the professional leaves the site or closes the window, the viewerplug-in instance is deleted. When the last instance of the viewerplug-in is deleted, the plug-in code is unloaded from memory.

Next, data files are downloaded to the viewer plug-in (step 410). In oneimplementation, the viewer plug-in downloads a data file from the dentalserver 102 using a suitable protocol such as a file transfer protocol(FTP). The viewer plug-in uses the downloaded file to present thetreatment plan graphically to the clinician. The viewer plug-in also canbe used by the treatment plan designer at the host site to view imagesof a patient's teeth. FIG. 8 shows an exemplary user interface for theviewer plug-in of FIG. 3. The professional can change views, select aparticular tooth and change its position as desired (step 412). 3-Dimages of various orthodontic views can then be rendered after eachinstruction from the treating professional is received (step 414).

Once the intermediate and final data sets have been created, theappliances may be fabricated as illustrated in FIG. 10. Commonfabrication methods employ a rapid prototyping device 501 such as astereolithography machine. A particularly suitable rapid prototypingmachine is Model SLA-250/50 available from 3D System, Valencia, Calif.The rapid prototyping machine 501 selectively hardens a liquid or othernon-hardened resin into a three-dimensional structure that can beseparated from the remaining non-hardened resin, washed, and used eitherdirectly as the appliance or indirectly as a mold for producing theappliance. The prototyping machine 501 receives the individual digitaldata sets and produces one structure corresponding to each of thedesired appliances. Generally, because the rapid prototyping machine 501may utilize a resin having non-optimum mechanical properties and whichmay not be generally acceptable for patient use, the prototyping machinetypically is used to produce molds which are, in effect, positive toothmodels of each successive stage of the treatment. After the positivemodels are prepared, a conventional pressure or vacuum molding machine551 is used to produce the appliances from a more suitable material,such as 0.03 inch thermal forming dental material, available fromTru-Tain Plastics, Rochester, Minn. 55902. Suitable pressure moldingequipment is available under the trade name BIOSTAR from Great LakesOrthodontics, Ltd., Tonawanda, N.Y. 14150. The molding machine 551produces each of the appliances directly from the positive tooth modeland the desired material. Suitable vacuum molding machines are availablefrom Raintree Essix, Inc.

After production, the appliances can be supplied to the treatingprofessional all at one time. The appliances are marked in some manner,typically by sequential numbering directly on the appliances or on tags,pouches, or other items which are affixed to or which enclose eachappliance, to indicate their order of use. Optionally, writteninstructions may accompany the system which set forth that the patientis to wear the individual appliances in the order marked on theappliances or elsewhere in the packaging. Use of the appliances in sucha manner will reposition the patient's teeth progressively toward thefinal tooth arrangement.

Because a patient's teeth may respond differently than originallyexpected, the treating clinician may wish to evaluate the patient'sprogress during the course of treatment. The system can also do thisautomatically, starting from the newly-measured in-course dentition. Ifthe patient's teeth do not progress as planned, the clinician can revisethe treatment plan as necessary to bring the patient's treatment back oncourse or to design an alternative treatment plan. The clinician mayprovide comments, oral or written, for use in revising the treatmentplan. The clinician also can form another set of plaster castings of thepatient's teeth for digital imaging and manipulation. The clinician maywish to limit initial aligner production to only a few aligners,delaying production on subsequent aligners until the patient's progresshas been evaluated.

FIG. 11 is a simplified block diagram of a data processing system 600that may be used to develop orthodontic treatment plans. The dataprocessing system 600 typically includes at least one processor 602 thatcommunicates with a number of peripheral devices via bus subsystem 604.These peripheral devices typically include a storage subsystem 606(memory subsystem 608 and file storage subsystem 614), a set of userinterface input and output devices 618, and an interface to outsidenetworks 616, including the public switched telephone network. Thisinterface is shown schematically as “Moderns and Network Interface”block 616, and is coupled to corresponding interface devices in otherdata processing systems via communication network interface 624. Dataprocessing system 600 could be a terminal or a low-end personal computeror a high-end personal computer, workstation or mainframe.

The user interface input devices typically include a keyboard and mayfurther include a pointing device and a scanner. The pointing device maybe an indirect pointing device such as a mouse, trackball, touchpad, orgraphics tablet, or a direct pointing device such as a touchscreenincorporated into the display, or a three dimensional pointing device,such as the gyroscopic pointing device described in U.S. Pat. No.5,440,326, other types of user interface input devices, such as voicerecognition systems, can also be used. User interface output devicestypically include a printer and a display subsystem, which includes adisplay controller and a display device coupled to the controller. Thedisplay device may be a cathode ray tube (CRT), a flat-panel device suchas a liquid crystal display (LCD), or a projection device. The displaysubsystem may also provide non-visual display such as audio output.

Storage subsystem 606 maintains the basic required programming and dataconstructs. The program modules discussed above are typically stored instorage subsystem 606. Storage subsystem 606 typically comprises memorysubsystem 308 and file storage subsystem 614.

Memory subsystem 608 typically includes a number of memories including amain random access memory (RAM) 610 for storage of instructions and dataduring program execution and a read only memory (ROM) 612 in which fixedinstructions are stored. In the case of Macintosh-compatible personalcomputers the ROM would include portions of the operating system; in thecase of IBM-compatible personal computers, this would include the BIOS(basic input/output system).

File storage subsystem 614 provides persistent (non-volatile) storagefor program and data files, and typically includes at least one harddisk drive and at least one floppy disk drive (with associated removablemedia). There may also be other devices such as a CD-ROM drive andoptical drives (all with their associated removable media).Additionally, the system may include drives of the type with removablemedia cartridges. The removable media cartridges may, for example behard disk cartridges, such as those marketed by Syquest and others, andflexible disk cartridges, such as those marketed by ‘omega. One or moreof the drives may be located at a remote location, such as in a serveron a local area network or at a site on the Internet's World Wide Web.

In this context, the term “bus subsystem” is used generically so as toinclude any mechanism for letting the various components and subsystemscommunicate with each other as intended. With the exception of the inputdevices and the display, the other components need not be at the samephysical location. Thus, for example, portions of the file storagesystem could be connected via various local-area or wide-area networkmedia, including telephone lines. Similarly, the input devices anddisplay need not be at the same location as the processor, although itis anticipated that personal computers and workstations typically willbe used.

Bus subsystem 604 is shown schematically as a single bus, but a typicalsystem has a number of buses such as a local bus and one or moreexpansion buses (e.g., ADB, SCSI, ISA, EISA, MCA, NuBus, or PCI), aswell as serial and parallel ports. Network connections are usuallyestablished through a device such as a network adapter on one of theseexpansion buses or a modem on a serial port. The client computer may bea desktop system or a portable system.

Scanner 620 is responsible for scanning casts of the patient's teethobtained either from the patient or from an orthodontist and providingthe scanned digital data set information to data processing system 600for further processing. In a distributed environment, scanner 620 may belocated at a remote location and communicate scanned digital data setinformation to data processing system 600 via network interface 624.Fabrication machine 622 fabricates dental appliances based onintermediate and final data set information received from dataprocessing system 600. In a distributed environment, fabrication machine622 may be located at a remote location and receive data set informationfrom data processing system 600 via network interface 624.

The invention has been described in terms of particular embodiments.Other embodiments are within the scope of the following claims. Forexample, the three-dimensional scanning techniques described above maybe used to analyze material characteristics, such as shrinkage andexpansion, of the materials that form the tooth castings and thealigners. Also, the 3D tooth models and the graphical interfacedescribed above may be used to assist clinicians that treat patientswith conventional braces or other conventional orthodontic appliances,in which case the constraints applied to tooth movement would bemodified accordingly.

What is claimed is:
 1. A method for dental treatment planning,comprising: receiving, by one or more computers, a set of diagnosticdata comprising one or more malocclusions and a current arrangement of apatient's teeth; executing, by the one or more computers, a firstevaluation routine for the set of diagnostic data comprising validatingthe set of diagnostic data at least against one or more case selectioncriteria for a desired treatment system, wherein successful validationindicates that the patient's teeth are acceptable for treatment usingthe desired treatment system; after successful validation by the firstevaluation routine, executing, by the one or more computers, a secondevaluation routine that evaluates the distance the teeth move betweenthe current arrangement and an initial desired arrangement against amagnitude of movement included in the one or more case selectioncriteria; after successful evaluation by the second evaluation routine,generating, by the one or more computers, a treatment plan for movingthe patient's teeth from the current arrangement toward the initialdesired arrangement of the patient's teeth using the set of diagnosticdata; outputting the data sets to a fabrication machine, the data setsbeing a shape of a plurality of appliances for treating the patients,wherein the data sets are configured to control a fabrication machine toproduce the plurality of appliances for treating the patient accordingto the outputted data sets.
 2. The method of claim 1, wherein the set ofdiagnostic data is indicative of at least one of: (a) which teeth arepresent, (b) condition of the teeth, (c) position of the teeth in arespective dental arch, (d) relationship of at least one tooth to otherteeth, (e) size of the teeth, or (f) alignment of the teeth.
 3. Themethod of claim 1, wherein the first evaluation routine furthercomprises detecting whether there is conflicting data in the set ofdiagnostic data.
 4. The method of claim 3, wherein the set of diagnosticdata comprises data of the patient's teeth from a plurality of views,and wherein the first evaluation routine comprises matching data of thepatient's teeth from a first view of the plurality of views to data ofthe patient's teeth from a second view of the plurality of views.
 5. Themethod of claim 3, further comprising generating feedback information ifconflicting data is detected in the set of diagnostic data.
 6. Acomputer system for dental treatment planning, comprising: one or moreprocessors; and memory, including instructions executable by the one ormore processors to cause the computer system to at least: receive, byone or more computers, a set of diagnostic data comprising one or moremalocclusions and a current arrangement of a patient's teeth; execute,by the one or more computers, a first evaluation routine for the set ofdiagnostic data comprising validating the set of diagnostic data atleast against one or more case selection criteria for a desiredtreatment system, wherein successful validation indicates that thepatient's teeth are acceptable for treatment using the desired treatmentsystem; after successful validation by the first evaluation routine,execute, by the one or more computers, a second evaluation routine thatevaluates the distance the teeth move between the current arrangementand an initial desired arrangement against a magnitude of movementincluded in the one or more case selection criteria; after successfulevaluation by the second evaluation routine, generate, by the one ormore computers, a treatment plan for moving the patient's teeth from thecurrent arrangement toward the initial desired arrangement of thepatient's teeth using the set of diagnostic data; output the data setsto a fabrication machine, the data sets being a shape of a plurality ofappliances for treating the patients, wherein the data sets areconfigured to control a fabrication machine to produce the plurality ofappliances for treating the patient according to the outputted datasets.
 7. The system of claim 6, wherein the instructions further causethe computer system to: generate a first set of questions relating to atreatment goal for the patient's teeth; receive, in response to thefirst set of questions, a set of treatment goal data relating to adesired arrangement of the patient's teeth; and execute a thirdevaluation routine for the set of treatment goal data comprisingvalidating the set of treatment goal data against at least one of theset of diagnostic data or one or more case selection criteria for thedesired treatment system, thereby determining feasibility of thetreatment goal.
 8. The system of claim 7, wherein the first set ofquestions are generated based on the set of diagnostic input data. 9.The system of claim 7, wherein the instructions further cause thecomputer system to: generate a second set of questions relating to adesired treatment path for the patient's teeth; receive, in response tothe second set of questions, a set of treatment path data relating to adesired treatment path for moving the patient's teeth toward the desiredarrangement; and execute a fourth evaluation routine for the set oftreatment path data comprising validating the set of treatment path dataagainst at least one of the set of diagnostic data, the set of treatmentgoal data, or the one or more case selection criteria for the desiredtreatment system, thereby determining feasibility of the desiredtreatment path.
 10. The system of claim 6, wherein the set of diagnosticdata is indicative of at least one of: (a) which teeth are present, (b)condition of the teeth, (c) position of the teeth in a respective dentalarch, (d) relationship of at least one tooth to other teeth, (e) size ofthe teeth, or (f) alignment of the teeth.
 11. The method of claim 6,wherein the first evaluation routine further comprises detecting whetherthere is conflicting data in the set of diagnostic data.
 12. The methodof claim 11, wherein the set of diagnostic data comprises data of thepatient's teeth from a plurality of views, and wherein the firstevaluation routine comprises matching data of the patient's teeth from afirst view of the plurality of views to data of the patient's teeth froma second view of the plurality of views.
 13. A computer system fordental treatment planning, comprising: one or more processors; andmemory, including instructions executable by the one or more processorsto cause the computer system to at least: receive, by one or morecomputers, a set of diagnostic data comprising one or more malocclusionsand a current arrangement of a patient's teeth; execute, by the one ormore computers, a first evaluation routine for the set of diagnosticdata comprising validating the set of diagnostic data at least againstone or more case selection criteria for a desired treatment system,wherein successful validation indicates that the patient's teeth areacceptable for treatment using the desired treatment system; aftersuccessful validation by the first evaluation routine, execute, by theone or more computers, a second evaluation routine that evaluates thedistance the teeth move between the current arrangement and an initialdesired arrangement against a magnitude of movement included in the oneor more case selection criteria; after successful evaluation by thesecond evaluation routine, generate, by the one or more computers, atreatment plan for moving the patient's teeth from the currentarrangement toward the initial desired arrangement of the patient'steeth using the set of diagnostic data; generate data sets correspondingto a shape of a plurality of appliances for treating the patients;generate fabrication instructions for a fabrication machine, theinstructions being based on the data sets and configured to cause afabrication machine to fabricate the plurality of appliances output thefabrication instructions to the fabrication machine, to cause thefabrication machine to produce the plurality of appliances.
 14. Thesystem of claim 13, wherein the treatment plan comprises a plurality oftreatment stages.
 15. The system of claim 14, wherein the instructionsfurther cause the computer system to generate data for fabricating oneor more dental appliances to move the patient's teeth from at least onetreatment stage of the plurality of treatment stages to anothertreatment stage of the plurality of treatment stages.
 16. The system ofclaim 15, wherein the instructions further cause the computer to:generate one or more questions regarding timing of delivery of the oneor more dental appliances; and receive one or more responses to the oneor more questions.
 17. The system of claim 15, wherein the instructionsfurther cause the computer to: execute a third evaluation routine forthe treatment plan comprising validating the treatment plan against oneor more properties of the one or more dental appliances.
 18. The systemof claim 13, wherein the set of diagnostic data is indicative of atleast one of: (a) which teeth are present, (b) condition of the teeth,(c) position of the teeth in a respective dental arch, (d) relationshipof at least one tooth to other teeth, (e) size of the teeth, or (f)alignment of the teeth.
 19. The system of claim 13, wherein the firstevaluation routine further comprises detecting whether there isconflicting data in the set of diagnostic data.
 20. The system of claim19, wherein the set of diagnostic data comprises data of the patient'steeth from a plurality of views, and wherein the first evaluationroutine comprises matching data of the patient's teeth from a first viewof the plurality of views to data of the patient's teeth from a secondview of the plurality of views.